Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Monday, May 24, 2010

"Hello, I'm Dr. Panda. What brings you folks in to the Emergency Department."

"I think my baby has an ear infection."

"What does your pediatrician think about it?"

"I didn't call."

"Why not?"

"I only call the pediatrician for important things."

And Another...

"Excuse me, do you know when that jackass doctor is going to get around to see me?"

"I'm the Jackass Doctor. We're really busy today and I will get to you as soon as I possibly can."

"I've been here for two hours."

"Sorry, I've had some really sick patients today."

"Man..I could have just gone to Wal Mart and got some cold medicine."

One More...

(Very Pleasant Gentleman in a Hall Bed)

"You know what, I can see that you're really busy today. I'm really not that sick. I think I'll just go home and call my doctor in the morning."

Bear With Me
Sure, my first post on this blog was something of a diatribe, laden with cliches and an exercise in dead horse flagellation. That there was nothing original in the whole article has been established definitively by many of my critics. I beg your indulgence. I have not written much over the last year and I'm a little rusty. In my defense, I have well over 700 pages of content on my old blog and if you think it's easy coming up with something original to say in every article I invite you to try it.

On the other hand, some things just need to be repeated again and again, particularly anecdotal evidence to support the general consensus that American Medicine is an insane Goat Rodeo organized and directed by the rodeo clowns who ensure that it is as difficult and expensive to deliver care as it can possibly be. The paperwork burden alone is phenomenal and grows every year defying any kind of reason or common sense except the inexorable logic of a rapidly expanding state and federal bureaucracy that exists to perpetuate and amplify this kind of thing in the circle jerk that we know as public service.

I am also amazed that, in exchange for the right to comment on American Goat Rodeodery, I must provide intricate solutions to its problems. In fact, the solutions are as obvious as they are difficult to implement and there is no amount of policy wonkery or 2000-page Health Care Bills That Nobody Read that will change the basic facts that we are ridiculously over-doctored, over-litigated, over-regulated, and over entitled. Or that most of the money spent on medical care is wasted and buys services that are at best horrifically redundant but mostly just unnecessary. Medical care, something that most people don't need much of most of the time has become the bloated tail wagging the corpulent national dog and is both the cause of our economic decline and the blunt instrument to be used by government to extend its influence into every aspect of your life. We have gone insane in this country harboring as we do a pathological fear that somebody, somewhere, somehow might be expected to pay for his own routine medical care.

Why, it might cut into his cigarette money.

It is this insanity that serves as a permanent obstacle to common sense things like meaningful medical malpractice reforms, ending the practice of futile care, holding people accountable for lifestyle decisions, and making it just a little more difficult for a 25-year-old methadone addict to collect disability.

Medical School Debt

I never said my debt was unmanageable. I just commented that the month between the end of residency and my first real paycheck was a difficult one. I'm actually paid pretty well, a lot more than I thought I would be making, and on that point I have no complaints. I imagine the economic outlook for Emergency Physicians will continue to improve as the wonder that is Obamacare unfolds on an unsuspecting public who will have trouble finding primary care doctors who are still in business. Hell, Emergency Departments are already swamped. I see between thirty and forty patients in a twelve hour shift and while not all of them are minor complaints, the vast majority are and when you take out the patients who are lazy, stupid, and irresponsible, a good portion of those are people who simply could not get a timely appointment with their own doctor.

I'm a special case in regard to debt anyway as I was a non-traditional medical student and resident. Generally, if you follow the normal path into medicine (college to medical school to residency to practice) your debt is very reasonable compared to your income and you would be stupid to ask the government to pay your way, thereby ensuring they have a first dibs on your ass at all times. The hardships of medical school debt, for most doctors, is something of a myth.

13 comments:

Man, Panda where do you practice??? That make believe town in TVLand where the Cleavers, Donna Reed, and Mr. Ed lived??You try that "What brings you folks into the Emergency Department?"(And why do you have to call it the Emergency "Department"? and not "Room", we might have to live with a British style Healthcare system but we don't have to talk like em)in the Dirty South and you'll hear...

A: "Da Bus"B: "Que.....????????"C: "Who Yew Callin "Folks" Mo-Fo?"D: "Arrggggummmmmahhhhhhh"(that unintelligible sound drunks make)E: "I was watching Manchester United on the Telly when I developed this tremendous pain in my left flank, 2 Paracetamols have done absolutley nothing, could I trouble you for a spot of Laudanum old Chap, and yes, I did just fly in on BOAC, but it would take me 3 years to be seen in an English Emergency Department"

and I've never understood doctors who complain about filled waiting rooms, thats who pays your paycheck, if only really sick people came to the ER it'd be like the old days, when the ER was really just a Room for emergencies, and you could get your appendix out for $20.Watta ya want, to sit on your ass and look at porn for $200/hr?? Shoulda gone into Anesthesia...

people need to chill the fuck out. of course some of your initial posts will be redundant. not everyone here knows who you are and your first post is an introduction.

i for one am glad to see you back. your writing style is immensely entertaining and your depiction of the numbskulls we deal with every day (patients, admin, other docs, etc etc) are spot on. i don't agree with your political views but whatever, that is what it is.

actually i do agree with you that the liberals are completely screwing the pooch with health care. but i happen to think the conservatives would do no better. i think their plan was to continue the status quo, slow march off the cliff into financial oblivion. the liberal plan takes that slow march and speeds it up into a comfortable jog. seeing that the reform health care actually needs probably won't happen until we are at or beyond the brink of collapse, one could argue that the liberal plan is better because it gets us there faster.

all i ask is that the collapse happen while i am still young and have some reserve, health-wise and money-wise, and not when i am old and more likely to be impacted by, say, every hospital in my state closing or a national doc strike.

and now off to 3 days of fast track, where docs' press-ganey scores go to die.

Medical care, something that most people don't need much of most of the time has become the bloated tail wagging the corpulent national dog and is the both the cause of our economic decline and the blunt instrument to be used by government to extend its influence into every aspect of your life.

fucking awesome British accent. and 'laudanum'? i haven't heard that since i watched "Tombstone", again (and cried, again).

and the parentheticals... what's with all the parentheticals?

and since you always make me want to get into my stream of consciousness mode... got home from a shift two nights ago (waiting room was full all day, crab were plentiful, the pots were full... oh by the way, nurses, it neither makes me speed up nor slow down or do anything when you update me every two minutes with 'three more just signed in!!!!!') and turned on to "E".

show? top 25 most voluptuous women... hosted by??? gay guys. is that the only way TV can do a great-looking women show anymore? gay guys? ruined a perfectly good show... too jarring.

12 hour shifts? they suck. are you doing the twelves on the 'fast track' side? do you then go to the 'acute side' for other shifts?

i'm a huge CS Lewis fan, but did not much like 'the screwtape letters'... however, his portrayal of hell as a rather quiet place, absent fire and brimstone, run by paper pushing, back-stabbing bureaucrats is great. the banality of evil.

"You don't need a prescription for Tylenol, it's available over the counter, in fact, you can buy it at the Dollar Store".

"But, if you write a prescription, my 'insurance' will pay for it".

"Mam, your cigarettes are $3 a pack, the Tylenol for your kid's fever is a buck, there's no reason for the tax payers (Medicaid) to buy it."

Another patient conversation last week:

(Drunk patient after his 6th seizure off medications in the last 5 months...)

"Are you taking your seizure medicine sir?"

"No, I haven't got any, my lawyer can't get my disability approved".

"Well sir, until that happens, you could purchase your medication. Your medication is $4 a month at WalMart, Target, and Walgreens".

"But, I don't have my disability yet".

"Sir, you could use those green rectangles that you exchange for beer and exchange a few of them for your medication instead. Wouldn't that be better than biting your tongue and hitting your head once or twice a month?"

These exchanges are ridiculous! I know I shouldn't be surprised by the stuff people say but it still gets me from time to time. Got any tips for someone about to start their third year rotations? You know... besides "run for your life."

Panda, I know your new at this game, but the only reason most patients ask for prescriptions is so they can see what your signature looks like so they can forge it on Oxycodone prescriptions. Helpful hint, if you do have to write an actual Rx, use a funny alias, I like Billy Rubin myself, if they really do use it for tylenol the pharmacist won't care, and if they try to get 500 tylenol #3's the DEA will wear out the soles of there shiny shoes interogating every Dr. Rubin in the state...

I hear Dr's talking about patient shenanigans and people going to the E.R. for dry eyes but when are the line level Dr's going to man up and just refer patients to the specialist they NEED to go to instead of making you come back time after time (work comp), probably getting paid a nickle or time from insurance for their lack of bedside mannor with me, to have my blood pressure read and see how the pain meds aren't working?